Healthcare Provider Details

I. General information

NPI: 1922065077
Provider Name (Legal Business Name): RICHARD M. VISE, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 12TH ST SUITE 3B
MERIDIAN MS
39301-4158
US

IV. Provider business mailing address

PO BOX 165
MERIDIAN MS
39302-0165
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-9223
  • Fax: 601-703-9405
Mailing address:
  • Phone: 601-703-9506
  • Fax: 601-703-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD M. VISE
Title or Position: OWNER
Credential: M.D.
Phone: 205-459-4778